Revenue Regulations No 16-2010 Guidelines, Rules & Procedures in the Filing of Confidential

Information & the Investigation of Cases
ANNEX A
BUREAU OF INTERNAL RENENUE
QUEZON CITY
Entry No.___________________
__________________
REPUBLIC OF THE PHILIPPINES
BUREAU OF INTERNAL REVENUE
QUEZON CITY
AFFIDAVIT
I, ________________________________________, ______ years of age,
married/single, and a resident of _______________________________________________,
after having been duly sworn in accordance with the law, depose and say:
1. That I am not a Bureau of Internal Revenue (BIR) official or employee, or other
public official;
2. That I am not related within the sixth civil degree of consanguinity to any BIR official
or employee, or other public official;
3. That I hereby furnish the information that __________________________________
___________________________________________________________________
___________________________________________________________________
__ (State definitely and specifically the facts constituting as grounds for the
information and frauds upon or violations of the internal revenue laws, either
contemplated or already effected.)
4. That to the best of my knowledge and belief, this information is not yet in the
possession of the Bureau of Internal Revenue; nor does this refer to any case of
fraud or violation already pending or previously investigated or examined by any
official or employee of the BIR or the Department of Finance;
5. That this information is given voluntarily and not for the purpose of harassing,
molesting or in any way prejudicing any person whatsoever;
6. That I request that this information be held strictly confidential; and
7. That I hereby reserve my right to claim for reward under Section 282 of the National
Internal Revenue Code, as amendment.
Done this ___th day of ___________, 20___

________________________
Affiant
SUBSCRIBED AND SWORN to before me this_____ day of ______________,
2010, affiant having exhibited to me his ______________________ issued at
_______________ on _________________
NOTARY PUBLIC

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